Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration

Deljou, Atousa; Hedrick, S.J.; Portner, Erica R; Schroeder, Darrell R.; Hooten, W. Michael; Šprung, Juraj; Weingarten, Toby N.

doi:10.1016/j.bja.2017.11.113

Cited by 65 publications

(99 citation statements)

References 31 publications

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“…Also, PPC rates were higher among patients on chronic benzodiazepine therapy. We previously found that chronic use of sedating medications in the general surgical population was associated with postoperative opioid-induced respiratory depression [10]. Pulmonary complications were also higher among patients undergoing emergent surgery.…”

Section: Discussionmentioning

confidence: 97%

“…At our institution patients undergoing anesthesia recovery are monitored for episodes of respiratory depression (termed respiratory specific events, which are nursing documented episodes of hypoventilation, apnea, oxyhemoglobin desaturation, or patient report of severe pain despite moderate to deep sedation) [8,9]. We have observed that among the general patient surgical population patients who have a respiratory specific event during anesthesia recovery are at a five-fold increased risk for severe opioid-induced respiratory depression on postsurgical wards [10,11]. Thus, a secondary aim of this study is to test the hypothesis that respiratory specific events (nursing documented episodes of respiratory depression) during anesthesia recovery are associated with subsequent development of PPCs in surgical patients with PH.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative pulmonary complications in contemporary cohort of patients with pulmonary hypertension

Kruthiventi

Kane

Šprung

et al. 2019

Bosn J of Basic Med Sci

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Patients with pulmonary hypertension are at increased risk for postoperative pulmonary complications (PPCs). Herein, we review PPCs in pulmonary hypertension patients undergoing non-cardiac procedures under general anesthesia. The medical records of pulmonary hypertension patients who underwent surgery with general anesthesia between 2010 and 2017 were reviewed for PPCs. In addition we reviewed nursing-documented respiratory depressive episodes in the post-anesthesia care unit to assess the associations between these episodes and later PPCs. There were 20 PPCs among 128 patients who underwent 197 procedures (10.2 per 100 surgeries) [95% CI 6.7–15.2]. Of these, 5 occurred during anesthesia recovery and 15 following anesthesia recovery. Three-quarters of the PPCs occurred within 24 postoperative hours. All the PPCs were severe. The frequency of PPCs was significantly higher in those who experienced respiratory depression during anesthesia recovery vs. in those who did not (5/17, 29% vs. 10/175, 6%; odds ratio 5.15, 95% CI 1.58–16.81, p = 0.007). Increased PPC rates were observed among patients who were current/previous smokers and who routinely use benzodiazepines, and among those undergoing emergent surgery. With treatment, all PPCs resolved. The rate of PPCs in the population of contemporary surgical pulmonary hypertension patients was 10.2%, and three-quarters occurred during first 24 postoperative hours. Patients who had respiratory depression during anesthesia recovery were 5-fold more likely to experience later PPCs.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Postoperative pulmonary complications in contemporary cohort of patients with pulmonary hypertension

Kruthiventi

Kane

Šprung

et al. 2019

Bosn J of Basic Med Sci

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“… 32 The continuation of home gabapentin/pregabalin into the postoperative period was strongly associated with a sixfold increase in OIRD in surgical wards. 33 In closed claims analysis, coadministration of sedatives and opioids occurred in 34% of postoperative OIRD. 10 …”

Section: Discussionmentioning

confidence: 99%

Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses

et al. 2018

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ObjectiveThis systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD).DesignSystematic review and meta-analysis.Data sourcesPubMed-MEDLINE, MEDLINE in-process, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed and Clinicaltrials.gov (January 1946 to November 2017).Eligibility criteriaThe inclusion criteria were: (1) adult patients 18 years or older who were administered opioids after surgery and developed postoperative OIRD (OIRD group); (2) all studies which reported both OIRD events and associated risk factors; (3) all studies with reported data for each risk factor on patients with no OIRD (control group) and (4) published articles in English language.Data analysisWe used a random effects inverse variance analysis to evaluate the existing evidence of risk factors associated with OIRD. Newcastle-Ottawa scale scoring system was used to assess quality of study.ResultsTwelve observational studies were included from 8690 citations. The incidence of postoperative OIRD was 5.0 cases per 1000 anaesthetics administered (95% CI: 4.8 to 5.1; total patients: 841 424; OIRD: 4194). Eighty-five per cent of OIRD occurred within the first 24 hours postoperatively. Increased risk for OIRD was associated with pre-existing cardiac disease (OIRD vs control: 42.8% vs 29.6%; OR: 1.7; 95% CI: 1.2 to 2.5; I2: 0%; p<0.002), pulmonary disease (OIRD vs control: 17.8% vs 10.3%; OR: 2.2; 95% CI: 1.3 to 3.6; I2: 0%; p<0.001) and obstructive sleep apnoea (OIRD vs control: 17.9% vs 16.5%; OR: 1.4; 95% CI: 1.2 to 1.7; I2: 31%; p=0.0003). The morphine equivalent daily dose of the postoperative opioids was higher in the OIRD group than in the control; (24.7±14 mg vs 18.9±13.0 mg; mean difference: 2.8; 95% CI: 0.4 to 5.3; I2: 98%; p=0.02). There was no significant association between OIRD and age, gender, body mass index or American Society of Anesthesiologists physical status.ConclusionPatients with cardiac, respiratory disease and/or obstructive sleep apnoea were at increased risk for OIRD. Patients with postoperative OIRD received higher doses of morphine equivalent daily dose.

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“…Potential confounders included in the analysis were based on existing literature and previous studies from our institution. [4,[18][19][20][21][22] Comparisons of outcomes between patients who had respiratory depression and those who did not were made using descriptive statistics. A two-tailed P-value of less than 0.05 was considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Postoperative respiratory depression after hysterectomy

Laporta

Kinney

Schroeder

et al. 2020

Bosn J of Basic Med Sci

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To investigate if sex-specific physiologic characteristics could impact postoperative respiratory depression risks in women, we studied incidence and risk factors associated with postoperative respiratory depression in a gynecologic surgical cohort. Only hysterectomies performed under general anesthesia from 2012 to 2017 were included to minimize interprocedural variability. Respiratory depression was defined as episodes of apnea, hypopnea, hypoxemia, pain-sedation mismatch, unplanned positive airway pressure device application, or naloxone administration in the post-anesthesia care unit. Multivariable logistic regression was used to explore the association with clinical characteristics. From 1,974 hysterectomies, 253 had postoperative respiratory depression, yielding an incidence of 128 (95% confidence interval, 114–144) per 1,000 surgeries. Risk factors associated with respiratory depression were older age (odds ratio 1.22 [95% confidence interval 1.02–1.46] per decade increase, p = 0.03), lower body weight (0.77 [0.62–0.94] per 10 kg/m2, p = 0.01), and higher intraoperative opioid dose (1.05 [1.01–1.09] per 10 mg oral morphine equivalents, p = 0.01); while sugammadex use was associated with a reduced risk (0.48 [0.30–0.75], p = 0.002). Respiratory depression was not associated with increased hospital stay, postoperative complications, or mortality. Postoperative respiratory depression risk in women increased with age, lower weight, and higher intraoperative opioids and decreased with sugammadex use; however, it was not associated with postoperative pulmonary complications.

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Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration

Abstract: Continuation of chronic gabapentinoid medications into the postoperative period is associated with the increased use of naloxone to reverse over-sedation or respiratory depression. Such patients requiring this therapy warrant high levels of postoperative monitoring.

Cited by 65 publications

References 31 publications

Postoperative pulmonary complications in contemporary cohort of patients with pulmonary hypertension

Postoperative pulmonary complications in contemporary cohort of patients with pulmonary hypertension

Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses

Postoperative respiratory depression after hysterectomy

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